Cross-hospital collaboration, speed of life and death: a 1-year-old girl with a foreign object in her airway was successfully rescued!

At 17:30 on the afternoon of February 18, the Pediatric Department of Yiyang Central Hospital received an emergency referral call from the Pediatric Department of Ziyang District Maternal and Child Health Hospital. A one-year-old girl named Tiantian was suffering from severe breathing difficulties due to a foreign body in her airway. Her condition was critical and she needed to be immediately transferred to Yiyang Central Hospital for emergency treatment.

One-year-old girl Tiantian ate pumpkin seeds at home. When her family prepared to wash her hair, they tilted her head back and she immediately developed breathing difficulties, cyanosis, and inability to shout. The family tried to scratch her throat but it did not help, so they immediately sent her to the nearest hospital.

After preliminary diagnosis, Tiantian was diagnosed with "airway foreign body", with a heart rate of only 40 beats per minute and blood oxygen saturation as low as 72%. Medical staff quickly initiated cardiopulmonary resuscitation and Heimlich maneuver, and called in a rapid response team to participate in the rescue, but the foreign body could not be expelled, and Tiantian's life was in danger.

Liu Yu, director of the Pediatrics Department of Ziyang District Maternal and Child Health Hospital, immediately contacted the Pediatrics Department of Yiyang Central Hospital and led the rescue team to transfer Tiantian to the Pediatric Intensive Care Unit (PICU) of Yiyang Central Hospital under the escort of the 120 ambulance. During the journey, Tiantian suffered from cyanosis, difficulty breathing, and a continuously decreasing heart rate. Medical staff continued to perform cardiopulmonary resuscitation in the ambulance, which bought precious time for subsequent rescue.

After receiving the call for help, the pediatric intensive care unit (PICU) team of Yiyang Central Hospital quickly prepared for rescue. The medical team headed by ward director Zhou Chao was on standby, and the two teams worked together to rescue the child. After the child arrived, the PICU team immediately continued to perform cardiopulmonary resuscitation. After about 2 minutes, the child's heart rate and blood oxygen saturation gradually returned to normal.

Afterwards, Director Zhou Chao and Deputy Chief Physician Cai Ling led the team to perform fiberoptic bronchoscopy and found that the foreign body was stuck in the glottis and difficult to remove. In the critical moment, Zhou Chao decisively pushed the foreign body into the opening of the right main bronchus and finally successfully removed the foreign body.

(Foreign bodies in the airway: pumpkin seed shells)

1. What is airway foreign body obstruction?

Foreign bodies in children's airways are a potentially life-threatening emergency, mostly occurring in children under 3 years old, with 1-2 year olds being the most susceptible. Severe airway obstruction by foreign bodies can cause suffocation and death in children. The golden first aid time for airway foreign body obstruction is only 4-6 minutes , so timely and rapid rescue is particularly important.

2. How to identify airway foreign body obstruction?

Symptoms of mild obstruction : Can breathe, can cough forcefully, and emit wheezing sounds;

Symptoms of severe obstruction : suffocation, inability to speak or shout (infants and young children struggle with their limbs and cry silently), weak or inability to cough, cyanosis of the face, and respiratory arrest.

3. How to provide first aid for airway foreign body obstruction?

Take appropriate measures according to the degree of obstruction

Treatment of mild obstruction: Do not interfere with the patient's spontaneous coughing, do not pat the patient's back or impact the patient's abdomen, closely monitor the patient's condition, and call emergency services when necessary.

Treatment of severe obstruction: Emergency measures should be taken immediately to relieve the obstruction as quickly as possible. If the patient becomes comatose, cardiopulmonary resuscitation should be started immediately.

First aid measures for severe airway obstruction

Use back percussion plus chest thrusts for infants and the Heimlich maneuver for older children.

Management of foreign body aspiration choking in children <1 year old

① Lay your baby’s head down on your arm or thigh.

② Use the base of your palm to pat the middle of the baby's back 5 times.

③If the obstruction still exists, turn the baby over and impact the lower half of the sternum 5 times.

④If obstruction persists, check the baby's mouth for any obstruction that can be cleared.

⑤ Repeat the above steps if necessary.

Management of foreign body aspiration choking in children aged >1 year

① With your child sitting, kneeling or lying on his or her stomach, pat the center of your child's back five times with the base of your palm.

② If the obstacle still exists, walk behind the child and put your arms around the child's body; use one hand to form a fist just below the child's sternum; put the other hand on the fist and pull it up into the abdomen; repeat this Heimlich maneuver 5 times.

③If the obstruction still exists, check the child's mouth for any obstructions that can be removed.

④ Repeat the above steps if necessary.

4. How to prevent the occurrence of airway foreign body obstruction?

Do not run, play, or laugh while eating;

Don’t eat large pieces of food too fast, chew them thoroughly before swallowing;

Cut food for infants and young children into small pieces with a hardness suitable for chewing. Avoid eating foods such as hard candies, grapes, jellies, and nuts that may easily cause aspiration obstruction .

Keep small objects that can be placed in the mouth away from infants and young children.

Hunan Medical Chat Special Author: Xia Le from Yiyang Central Hospital

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(Edited by Wx)